2010 Award Finalist

Treatment & Assessment Care Centre - Improving access to ER care for CTAS 2

Category - Improving Evidence-Based Practice

The Problem

The Canadian Triage and Acuity Scale (CTAS) is a way of more accurately defining patients' needs for timely care. It allows Emergency Departments to evaluate acuity level, resource needs and performance. Under CTAS, Level 1 patients need to be seen by a physician immediately 98% of the time, Level 2 patients need to be seen within 15 minutes 95% of the time, and Level 3 patients need to be seen within 30 minutes 90% of the time. The Credit Valley Hospital moved to improve wait times for CTAS level III patients in March 2006. Measurable improvement was achieved with the implementation of a rapid assessment zone (RAZ). However, continuous monitoring demonstrated CTAS level II wait times were increasing due to insufficient stretcher capacity and increasing volumes.

The Innovation

The aim of the Treatment and Assessment Care Center (TACC) which opened April 15th 2009 is to build on the success Credit Valley enjoyed with CTAS level 3 and apply it to CTAS level 2 wait times, through an enhanced patient experience. The approach involves a new care model that supports team work, includes patients in decision making, and addresses the issues of safety and risk. Changes were made to the process for treatment and assessment of patients. Patients are now brought in from the waiting area earlier and a team approach is used to move the patient through the ED process of care. The patient no longer requires a designated ED space to be seen. The process is streamlined because the steps are done in parallel. A LEAN project was also undertaken in January 2010 to review workflow and equipment requirements, and standardized equipment and supplies in this work area were brought in as a result.

The Results

The key benefits are evidenced by the emergency team commitment to the vision of creating better healthcare. In order to deliver safe, quality and patient focused hospital care the team continues to strive for excellence, diversity, teamwork and leadership. This TACC initiative demonstrates the ED teams' ability to assist the organization in meeting the strategic goals of quality, access and sustainability. The team is viewed as a strong community partner, through participation at the LHIN and by sharing their success stories with external stakeholders to improve the care for all residents within our province. The TACC project has been highlighted at several ED conferences..

Next Steps

Credit Valley continues to work to improve consultation turnaround time, by revising triage documentation to reduce redundancy and by implementing separate adult and paediatric documentation processes to improve efficiency and reduce over-processing. In addition, continuous quality improvement audits will be used to measure sustainability, such as compliance with 5S targets and assessment of return visits to the ED.